Health
9:44 am
Thu March 29, 2012

Escaping Florida’s Medicaid Experiment

Last year, Florida legislators passed a bill privatizing the state’s Medicaid program, moving recipients into managed care plans – a model patterned on a pilot program that’s been running in five counties since 2006.

The statewide change still needs federal approval – and for one family already living in a pilot county, it’s a troubling prospect.

HealthyState.org reporter Sammy Mack visits this Broward County family to find out why one mother has decided to leave so her son can get better access to health care, and brings us this story:

“It has not been a pleasant experience for us,” says Lea Jean-Baptiste of Broward County. For the past ten years, her 13-year-old son, DeAndre, has received health care through Medicaid because he has a rare genetic disorder. When Broward became a pilot county for the state’s Medicaid managed care trial, Jean-Baptiste says the obstacles to getting care for her son became overwhelming.

“It really has been a mixed bag of reviews,” says Dr. Fernando Valverde, CEO of FIU Health in South Florida. ”From the patient side you had a lot of complaints that you lost your freedom of choice and people lost their physicians and their hospitals.”

According to research from the University of Florida, Jean-Baptiste’s experience does not represent the experience of most Medicaid recipients under the pilot. In a survey conducted by UF, about one in 10 Medicaid recipients in the first pilot counties gave poor ratings to their overall health care. And in its initial couple of years, the pilot saved between $6 and $176 per person every month, depending on why that person was eligible for Medicaid.

“We’ve seen a lot of benefits as we’ve tracked – it’s a very accountable program,” says Justin Senior, deputy secretary for Florida Medicaid.

Even so, Senior acknowledges, “change is difficult.”

Jean-Baptiste says that at first, Medicaid was a lifeline, but when the county moved to managed care, everything felt like a struggle. For her, coordinating all of the caregivers – including an army of specialists – has been a logistical nightmare of paperwork and delayed care.

But perhaps the hardest part of the experience is being shut out of bimonthly reviews of her son’s case.

“We are the voice for our children,” says Jean-Baptiste. “They can’t speak for themselves.”

Jean-Baptiste is so fed up with fighting through the pilot in Broward, she’s moving across county lines to Miami-Dade County so that her son doesn’t have to be part of the managed care experiment anymore.

Still, she holds hope that if Florida gets approval and her son ends up back in managed care, the rough patches will have been smoothed out by then.

“Hopefully it’ll be something different and hopefully it’ll be some other people that know how to manage it a little better,” says Jean-Baptiste.

To read more about the financial state of Florida’s Medicaid and whether or not managed care can help shore it up, read Dave Gulliver’s story. And to find out why doctors don’t take Medicaid, read Farah Dosani’s story.

This reporter can be reached at smack@miamiherald.com. Sammy Mack reported this story with the support of Kaiser Health News and NPR’s Health Care In The States project.